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MERCHANT QUALIFICATION FORM
Merchant Name
Contact Name
Phone
Email
Enter URL
Products/Services Sold
Current Accepting Credit Cards?
Estimated Monthly Card Processing Volume
Estimated Avg Ticket
RETAIL STOREFRONT
POS software name or Standalone Terminal Make/Model
If Terminal, is it STANDALONE or Fully Integrated into a POS Software
Do you currently OWN your terminal/equipment, or are you on any type of rental or placement program in which you would have to send your terminal back to your current provider?
Currently processing an online/Ecomm storefront too?
ECOMMERCE
Web hosting platform (WordPress, Shopify, etc)
Shopping Cart currently using (WooComm, Magento, etc)
Who handles your website development? (internal person or external contractor? Don’t need name this moment but assuming they get up and running with us this will be the contact we need to provide our merchant account details with so he/she can integrate it into their website)
ECOMMERCE
Terminal make/model
Is the terminal currently using 4g/LTE in order to accept payments anywhere there is cell phone service available? (and/or using wifi connection when wifi is available)
Do you currently OWN your terminal/equipment, or are you on any type of rental or placement program in which you would have to send your terminal back to your current provider?
PHONE ORDER
Are you currently using an online ‘Virtual Terminal’ to key in your transactions that you accept over the phone?
• What Virtual Terminal or online Gateway are you using today (Authorize.net, NMI, Cybersource, etc)
OTHER
Notes on Other
FINAL QUESTIONS
What are your main reason(s) for wanting to switch payment processing providers?
Are there any things that are really important to you related to your payment processing that you would like to be new or better?
What is your timeframe for wanting to switch from your current payment processing provider?
Can you please email us your last 3 months Visa/MC merchant processing statements.
SUBMIT
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